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Pharmacy Practice I > Pain I > Flashcards

Pain I Flashcards

1
Q

Pain

A
  • Pain: unpleasant sensory and emotional experience of actual or potential tissue damage
  • Tissue damage release chemical substances: prostaglandin (PG), bradykinin, histamine, seratonin, substance P
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2
Q

Types of Headaches

A

-Primary Headaches:
Chronic tension-type headache
Migraine headache
Medication overuse headache

  • Secondary Headaches
  • Sinus Headache
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3
Q

Tension Type Headaches

A

Signs and Symptoms
 Bilateral, diffuse pain of head: may radiate to neck and shoulders, “tight band” across head, related to stress / anxiety / depression
 Location: over top of head, extending to base of skull
 Severity: varies
 Onset: gradual
 Duration: minutes to days

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4
Q

Migraine Headaches

A

 Signs and Symptoms
-With aura (“classic”) or without aura (may last up to 30 minutes), neurologic: flashing areas, blind spots, difficulty speaking, visual or auditory hallucinations
-Followed by throbbing headache pain (if no aura, starts with throbbing pain)
 Location: usually unilateral
 Onset: sudden
 Duration: hours to 2 days
 Associated symptoms: nausea/vomiting, photophobia, phonophobia, tinnitus, light- headedness, vertigo
 Quality of life: causes absenteeism and lost productivity at work, affects personal relationships

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5
Q

Sinus Headaches

A

 Signs and symptoms
-Onset: simultaneous with sinus symptoms, including purulent nasal discharge
 Duration: resolves with sinus symptoms

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6
Q

When to Refer to PCP for Headache

A
  • Severe head pain
  • Headaches that persist for 10 days with or without treatment
  • Last trimester of pregnancy
  • <8 years of age
  • High fever or signs of serious infection
  • History of liver disease (consumption of alcohol > 3 alcoholic drinks per day)
  • Questionable secondary headache
  • No formal diagnosis of migraine headache
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7
Q

Non-Medication Therapies for Headache

A
  • Relaxation exercises
  • Adequate sleep
  • Proper eating habits
  • Ice packs
  • Pressure to affected area
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8
Q

Osteoarthritis

A
  • A.k.a degenerative joint disease (DJD)
  • Weight-bearing
  • Breakdown and eventual loss of the cartilage in one or more joints
  • Worsens with age
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9
Q

Non-Medication Therapy for Osteoarthritis

A
  • Activity Modification: rest as much as possible, substitute less mechanically stressful activities, assistive aids
  • Warm shower or bath
  • Ice pack on painful areas
  • Light exercise with initial gentle stretching
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10
Q

Assistive Devices for Osteoarthritis

A
  • Wheels
  • Hand/wrist savers
  • Bathroom benches, raised seats, hand rails
  • Kitchen tools / gadgets
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11
Q

Treatment Goals for Pain and Headache

A
  • To alleviate acute pain
  • To restore normal functioning
  • Prevent relapse
  • Minimize side effects
  • For chronic headache: to reduce frequency of headaches
  • For osteoarthritis: decrease rate of progression of disease with focus on ADLs
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12
Q

Over the Counter Products

A

-NSAIDs (non-steroidal anti-inflammatory drugs)
 Ibuprofen (Motrin®, Advil®)
 Naproxen (Aleve®)
 Ketoprofen (Orudis®)
-Salicylates: also relieves inflammation
 Aspirin (acetylsalicylic acid)
 Choline salicylate (Arthropan®)
 Magnesium salicylate (Doan’s® )
-Acetaminophen (Tylenol®): not effective for inflammation

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13
Q

NSAIDs: Mechanism of Action

A
  • Inhibit prostaglandin synthesis by inhibiting both isoforms of the enzymes cyclooxygenase (COX-1 and COX-2)
  • The resulting decrease in prostaglandins reduces the sensitivity of pain receptors to the initiation of pain impulses at sites of inflammation and trauma
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14
Q

NSAIDs & Aspirin Pharmacology

A

 Cyclooxygenase enzymes

  • COX-1: cytoprotection of stomach/intestine and kidneys, and aggregation and vasoconstriction of platelets
  • COX-2: pain, inflammatory response induced by macrophages, fribroblasts, platelets
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15
Q

NSAIDS and Aspirin Adverse Effects

A
  • Gastrointestinal
  • Renal complications
  • Platelet dysfunction/clotting problems
  • Cardiac complications
  • Hypersensitivity/Allergy
  • Reye’s syndrome
  • Stevens Johnsons Syndrome
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16
Q

GI Effects

A
  • Local irritant from drug contacting GI mucosa
  • Systemic effect from prostaglandin inhibition
  • GI bleeds
  • High risk: advanced age, alcohol abuse / ingesting with alcohol, liver disease, gastric ulcerations, higher dose or longer duration
  • Take with food/milk, combine with PPI/H2
  • EC: Do not take with antacids, do not crush or chew EC aspirin
17
Q

Renal (Kidney) Complications

A

-Decreased renal blood flow
-Inhibition of protective PGs on kidney
 Concerns of concomitant use of NSAIDs/ASA and advanced age, diabetes, hypertension, congestive heart failure, cardiovascular disease (atherosclerosis)
 High risk patients should not self-medicate with NSAIDs

18
Q

Clotting Problems

A

-NSAIDs will increase risk of bleeding
-Avoid NSAIDs in patients with platelet dysfunction or thrombocytopenia
-Avoid combining NSAIDs with
anticoagulants and antiplatelet meds
-NSAIDs: stop 48 hours before surgery and restart once patient is no longer at bleeding risk

19
Q

Cardiovascular Side Effects

A
  • NSAIDs associated with increased risk for myocardial infarction, congestive heart failure, hypertension and stroke
  • Dose and duration dependent
  • American Heart Association recommends that patients with or at high risk for cardiovascular disease should avoid NSAIDs
20
Q

Aspirin Allergy

A
  • Signs/Symptoms: urticaria (hives), angioedema (rapid swelling of skin mucosa), difficulty breathing, bronchospasm, profuse rhinorrhea, and shock
  • Onset: Occurs within 3 hours of aspirin ingestion
  • Reye’s Syndrome: Associated with aspirin use (rarely occurs but avoid use in children < 15 yo)
  • Applies to all drugs containing salicylates e.g. Pepto-Bismol
  • Main effect: increased pressure in the brain and massive accumulations of fat in the liver / other organs
21
Q

Low Dose Aspirin

A

Role of low dose aspirin

  • Low dose refers to: 81mg po daily or325mg po every other day or 1⁄2 of 325mg tab daily
  • This dose does not provide analgesic, antipyretic or anti-inflammatory effects
  • Used for prevention of myocardial infarction in high risk patients (e.g. previous MI, CAD, DM)
22
Q

NSAIDs & Aspirin Interactions

A

Drug Interactions

  • Ibuprofen (and other NSAIDs) may block the cardio-protective effects of aspirin (ASA)
  • Competitive inhibition for platelet COX acetylation site
  • Give ASA at 1 hour before NSAID OR wait at least 8 hours after administering NSAID to give ASA

Drug-Disease Interactions
-Hypertension, Diabetes Mellitus (DM), Congestive Heart Failure (CHF), Impaired renal function, Gout

Pharmacy Practice I (27 decks)

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